Provider Demographics
NPI:1669731030
Name:KUPRIYANOVA, TAISIYA (RD, CDCES, CSOWM)
Entity type:Individual
Prefix:
First Name:TAISIYA
Middle Name:
Last Name:KUPRIYANOVA
Suffix:
Gender:F
Credentials:RD, CDCES, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4100
Mailing Address - Country:US
Mailing Address - Phone:408-871-3400
Mailing Address - Fax:
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-871-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered